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Grand Rounds

Robotic vs Vaginal vs Open Surgery for Vaginal Prolapse – How Do They Compare?

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BACKGROUND AND PURPOSE:

  • There is limited evidence regarding the best approach for repair of vaginal apex prolapse
  • Anand et al. (Female Pelvic Medicine Reconstructive Surgery, 2017) assessed treatments for posthysterectomy vaginal vault prolapse
  • Hypothesis: Rates of symptom relief and survival free of retreatment would be higher in the open abdominal sacrocolpopexy group compared to Robotic and Mayo-McCall culdoplasty

METHODS:

  • Retrospective cohort study of patients who underwent surgery for posthysterecotmy apical vaginal prolapse
  • Authors compared degrees of symptom relief and survival free of retreatment after
    • Mayo-McCall culdoplasty (MMC)
      • Modification of uterosacral ligament suspension
    • Open abdominal sacrocolpopexy (ASC)
    • Robotic sacrocolpopexy (RSC)
  • Baseline characteristics, intraoperative and postoperative outcomes were taken from electronic health records
  • Patients answered validated questionnaires to acquire cross-sectional data for current pelvic floor symptoms
  • Propensity score methodology was used to deal with patient selection bias

RESULTS:

  • 512 women were included in the cohort study
    • 337 completed the questionnaire
    • Median follow up was 4.5 years for the MMC group | 5.2 years for the ASC group | 2.9 years for the RSC group
  • There was no significant difference between groups for:
    • Overall Pelvic Floor Distress Inventory 20
    • Pelvic Floor Impact Questionnaire Short Form 7
    • Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire 12 summary scores
  • There were no significant differences in 5-year survival free of retreatment for
    • MMC (94.0%) vs RSC (95.5%)
    • ASC (94.8%) vs RSC (92.1%)
  • There were significantly more patients that underwent retreatment in the first 10 years in the MMC (81.1% survival free of retreatment) vs ASC group (95.4% survival free of retreatment)
    • Hazard Ratio 3.68 (95% CI 1.51-8.98)
  • 10-year follow-up data for RSC comparisons was not included for historical reasons (recent entry of RSC as a surgical alternative)

CONCLUSION:

  • Symptom relief and 5-year retreatment rates were similar between the MMC, ASC, and RSC groups
  • Compared to MMC, ASC is more durable, with higher survival free of retreatment within 10 years, although MMC still had favorable rates

Learn More – Primary Sources:

Symptom Relief and Retreatment After Vaginal, Open, or Robotic Surgery for Apical Vaginal Prolapse.

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Related ObG Topics:

Mesh and Pelvic Organ Prolapse: ACOG Practice Advisory & ACOG/AUGS Recommendations 
Comparing the Use of Mesh Against Standard Repair for Prolapse
Is Pelvic Muscle Strengthening Effective Following Pelvic Surgery for Prolapse and Incontinence?

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